Thresholds and Mortality Associations of Paraspinous Muscle Sarcopenia in Older Trauma Patients

Based on CT scans at the 12th thoracic spine level, assessing the impact of skeletal muscle and adipose tissue index on one-year postoperative mortality in elderly hip fracture patients: a propensity score-matched multicenter retrospective study

BACKGROUND

Research has demonstrated that individuals with sarcopenia or sarcopenic obesity who experience fractures or undergo major surgical interventions exhibit a poorer prognosis compared to the general population. However, few studies have investigated the relationship between the skeletal muscle and adipose tissue indices, as measured at the 12th thoracic spine level, and adverse outcomes following orthopedic surgery. Therefore, this study aimed to prove whether skeletal muscle and adipose tissue index measured by computed tomography (CT) images based on a single layer are associated with one-year postoperative mortality in elderly hip fracture patients.

METHODS

A total of 334 participants from two institutions were enrolled in this study to obtain skeletal muscle index (SMI), subcutaneous fat index (SFI), visceral fat index (VFI), and the visceral-to-subcutaneous ratio of the fat area (VSR) at T12 levels and divide them into death and survival groups based on the results of follow-up after 1 year. Propensity score matching (PSM) was employed to evaluate one-year postoperative mortality.

RESULTS

Institution 1's results identified that a lower SMI significantly heightened the risk of one-year postoperative mortality (OR = 0.799,95%CI 0.677-0.943, P = 0.008), making SMI an independent predictor. Institution 2's results identified that age (OR = 1.081, 95%CI 1.005-1.163, P = 0.036), SMI (OR = 0.881, 95%CI 0.784-0.991, P = 0.035) as independent predictors of one-year postoperative mortality in elderly hip fracture. Receiver operator characteristics analysis revealed area under the curve (AUC) values for institution 1: SMI (0.738 (95%CI 0.626-0.851), significant), VFI (0.605 (95%CI 0.476-0.734)), VSR (0.583 (95%CI 0.451-0.715)); and for institution 2: SMI (0.742 (95%CI 0.612-0.872), significant) and Age (0.775 (95%CI 0.677-0.874), significant). Collectively, these results underscore that SMI serves as an independent predictor of one-year postoperative mortality in elderly hip fracture patients.

CONCLUSION

This study demonstrated that the T12-based SMI was independently associated with one-year mortality following hip fracture in geriatric patients, with lower preoperative SMI correlating with higher mortality rates post-surgery.

Causal Relationship Between Circulating Metabolites and Sarcopenia-Related Traits: A Mendelian Randomization and Experimental Study

Sarcopenia (SP), an age-associated condition marked by muscle weakness and loss has been strongly connected with metabolic factors according to substantial evidence. Nevertheless, the causal correlation between SP and serum metabolites, and the biological signaling pathways involved, is still not well understood. We performed a bidirectional two-sample Mendelian randomization (MR) analysis to examine the causal relationships between 1091 levels and 309 ratios of metabolites with SP traits, alongside investigating the relevant biological signaling pathways. Additionally, we explored the differential expression of plasma metabolites and potential biological signaling pathways in an animal model of SP. When SP was utilized as the outcome, we identified 11 robust causal associations between seven metabolite levels/ratios and SP-related traits using Bonferroni's correction (threshold: p < 0.05). We verified the stable causal association of glycine levels and SP in the validation. As for the reverse MR analysis, there were 11 strong causal relationships with 11 plasma metabolite levels/ratios remaining after multiple contrast correction. Additionally, biological signaling pathway analysis showed that glycine metabolism, insulin resistance, and cAMP signaling pathways may contribute to the connection between metabolites and SP. Mendelian validation of various datasets and observations in animal serum metabolomics suggests a strong association between glycine metabolism and SP. Our results indicate that the identified metabolites and biosignaling pathways could serve as important circulatory metabolic biomarkers for the screening and prevention of SP in clinical settings. Additionally, they represent potential molecules for future exploration of mechanisms and selection of drug targets.

Sex differences in the association between chest computed tomography-defined sarcopenia and cardiovascular risk factors among inpatients

Background

While sarcopenia has been found to be associated with increased risks of cardiovascular diseases (CVDs), evidence exploring sex-related differences remains insufficient. This study aimed to investigate the differences in how often sarcopenia occurs in each sex, as determined by skeletal muscle area (SMA) in chest CT images, and its association with CVD common risk factors.

Methods

This cross-sectional study involved 1,340 inpatients from the Department of Geriatrics of Renji Hospital, affiliated to Shanghai Jiaotong University School of Medicine. Data on age, sex, body mass index (BMI), smoking status, disease history, and clinical parameters were collected. Sarcopenia was defined using chest CT images with a cut-off value of T12-SMA/height2 <25.75 cm2/m2 in male patients and <20.16 cm2/m2 in female patients. Cardiovascular risk was assessed using the Framingham risk score (FRS). The association between T12-SMA/height2-defined sarcopenia and CVD risk factors by sex was evaluated using a multivariate logistic regression analysis.

Results

The overall prevalence of T12-SMA/height2-defined sarcopenia (<25.75 cm2/m2 for male patients, <20.16 cm2/m2 for female patients) was 54.03%, with 48.09% in male patients and 63.19% in female patients. The proportion of male patients with high CVD risk was greater than that of female patients. The multivariate analysis revealed that T12-SMA/height2-defined sarcopenia was independently associated with age (in male patients only), systolic blood pressure (SBP), cholesterol, and high-density lipoprotein cholesterol (HDL-C) among the six FRS cardiovascular risk indices.

Conclusion

Our results suggest that T12-SMA/height2-defined sarcopenia was more prevalent in male patients than in female patients. Sarcopenia was associated with higher levels of SBP and HDL-C and lower levels of cholesterol. Increasing age had a more significant effect on CVD risk in male patients.

Causal associations between sarcopenia-related traits and intervertebral disc degeneration: a two-sample mendelian randomization analysis

BACKGROUND

Sarcopenia (SP) and intervertebral disc degeneration (IVDD) have a higher incidence in the elderly population. Previous studies have indicated a potential association between SP and IVDD. The objective of this study is to elucidate the potential causal relationship between sarcopenia-related traits and IVDD through Two-sample Mendelian randomization (MR) analysis.

METHODS

We utilized a genome-wide association study conducted on the European population to collect aggregated data on sarcopenia and IVDD. Inverse variance weighting was primarily employed, supplemented by MR Egger, weighted median, simple model, and weighted model methods. Additionally, sensitivity analysis was performed to assess the robustness of the findings.

RESULTS

Appendicular lean mass is positively associated with "Other intervertebral disc disorders" (OIDD) and "Prolapsed or slipped disc" (POSD) (OIDD: p = 0.002, OR = 1.120; POSD: p < 0.001, OR = 1.003), while grip strength (GS) is positively associated with POSD (left: p = 0.004, OR = 1.008; right: p < 0.001, OR = 1.010). It is worth mentioning that walking pace has significant causal relationship with "Low back pain" (LBP), "Lower back pain or/and sciatica" (LBPOAS), "Sciatica with lumbago" (SWL) and OIDD (LBP: p < 0.001, OR = 0.204; LBPOAS: p < 0.001, OR = 0.278; SWL: p = 0.003, OR = 0.249; OIDD: p < 0.001, OR = 0.256).

CONCLUSION

The present study revealed the causal relationship between SP-related traits and IVDD and recommended to prevent and treat sarcopenia as a means of preventing IVDD in clinic practice.

Multimodal prerehabilitation for elderly patients with sarcopenia in colorectal surgery

Sarcopenia, which is characterized by progressive and generalized loss of skeletal muscle mass and strength, has been well described to be associated with numerous poor postoperative outcomes, such as increased perioperative mortality, postoperative sepsis, prolonged length of stay, increased cost of care, decreased functional outcome, and poorer oncological outcomes in cancer surgery. Multimodal prehabilitation, as a concept that involves boosting and optimizing the preoperative condition of a patient prior to the upcoming stressors of a surgical procedure, has the purported benefits of reversing the effects of sarcopenia, shortening hospitalization, improving the rate of return to bowel activity, reducing the costs of hospitalization, and improving quality of life. This review aims to present the current literature surrounding the concept of sarcopenia, its implications pertaining to colorectal cancer and surgery, a summary of studied multimodal prehabilitation interventions, and potential future advances in the management of sarcopenia.

Diagnostic Value of Sarcopenia Computed Tomography Metrics for Older Patients with or without Cancers with Gastrointestinal Disorders

OBJECTIVES

The diagnostic utility of poor body composition measures in sarcopenia remains unclear. We hypothesize that the skeletal muscle gauge [combination of skeletal muscle index (SMI) and skeletal muscle density (SMD); SMG = SMI × SMD] would have significant diagnostic and predictive value in certain muscle regions and populations.

DESIGN

Prospective cross-sectional study.

SETTING AND PARTICIPANTS

We examined inpatients age ≥60 years with or without cancer and with gastrointestinal disorders.

METHODS

We used computed tomography (CT) image metrics in the 12th thoracic (T12), third lumbar (L3), erector spinae muscle (ESM), and psoas muscle (PM) regions to establish correlations with the 2019 Asian Working Group for Sarcopenia Consensus and used receiver operating characteristic area under the curve (AUC) to compare differences between metrics. Associations between CT metrics and mortality were reported as relative risk after adjustments.

RESULTS

We evaluated 385 patients (median age, 69.0 years; 60.8% men) and found consistent trends in cancer (49.6%) and noncancer (50.4%) cohorts. SMG had a stronger correlation with muscle mass than SMD [mean rho: 0.68 (range, 0.59‒0.73) vs 0.39 (range, 0.28‒0.48); all P < .01] in T12, L3, and PM regions and a stronger correlation with muscle function than SMI [mean rho: 0.60 (range, 0.50‒0.77) vs 0.36 (range, 0.22‒0.58); all P < .05] in T12, ESM, and L3 regions. SMG outperformed SMI in diagnostic accuracy in all regions, particularly for L3 (AUC: 0.87‒0.88 vs 0.80‒0.82; both P < .05). PMG (PM gauge) and L3SMG did not differ, whereas EMG (ESM gauge) or T12SMG and L3SMG did (AUC: 0.80‒0.82 vs 0.87‒0.88; all P < .05). L3SMI, L3SMD, T12SMG, EMG, and PMG showed no association with 1-year cancer-related mortality after adjusting for confounders; however, L3SMG [relative risk = 0.92 (0.85‒0.99); P = .023) was.

CONCLUSIONS AND IMPLICATIONS

L3SMG covers all features of sarcopenia with more diagnostic value than other metrics, allowing a complete sarcopenia assessment with CT alone and not just in populations with cancer.

High blood urea nitrogen to creatinine ratio is associated with increased risk of sarcopenia in patients with chronic obstructive pulmonary disease

BACKGROUND AND AIMS

Sarcopenia has been reported to be a prognostic factor for chronic obstructive pulmonary disease (COPD). However, the relationship between the ratio of blood urea nitrogen to creatinine (BUN/Cr) and sarcopenia in patients with COPD remain unclear. Therefore, the purpose of this study is to explore whether the ratio can be used as a predictor of sarcopenia in hospitalized COPD patients.

METHODS

The skeletal muscle area index (SMI) at the level of the 12th thoracic vertebra (T12) was used to assess the risk of sarcopenia in patients. This single center cross-sectional study was conducted by analyzing the clinical parameters and identifying the T12 skeletal muscle area (SMA) and density (SMD) on chest CT images of COPD hospitalized patients admitted to the respiratory department of our hospital from March 2018 to August 2021. The study enrolled 265 hospitalized patients. Based on the different statistical properties of the above variables, differences between groups were measured by independent sample Student t-tests, Mann-Whitney U tests, or Chi-Square tests. Multivariable linear regression analysis was used to evaluate the relationship between the value of BUN/Cr and the risk of sarcopenia.

RESULTS

The serum BUN/Cr ratio was negatively correlated with SMI (r = -0.201, p = 0.001) in COPD patients, and multivariate linear regression analysis showed that this ratio was associated with the risk of sarcopenia (β = -0.109, p = 0.041). The optimal cut-off value of BUN/Cr ratio for identifying COPD patients with sarcopenia was 97.893. There was also a significant negative correlation between serum BUN/Cr ratio and forced vital capacity (FVC; r = -0.235, p < 0.001) and forced expiratory volume in the first second (FEV1; r = -0.219, p < 0.001).

CONCLUSION

The BUN/Cr ratio can be used to predict sarcopenia and evaluate pulmonary function in hospitalized COPD patients.

Prognostic Effect of Thoracic Sarcopaenia on Short- and Long-Term Clinical Outcomes in Patients Underwent Cardiac Valve Surgery

BACKGROUND

As the proportion of elderly patients increases, higher incidence of malnutrition is found among patients with valvular heart disease. Sarcopaenia is one of the main manifestations of malnutrition. Studies have shown the certain predictive effect of sarcopaenia on the clinical outcome in different cases. This study aims to clarify the impact of computed tomography (CT)-derived thoracic sarcopaenia on clinical outcomes of patients underwent cardiac valve surgery.

METHODS

The clinical data of 216 patients who underwent cardiac valve surgery from December 2015 to June 2020 were retrospectively collected. Skeletal muscle mass at 12^th thoracic vertebra level was measured to diagnose thoracic sarcopaenia. Postoperative complications and follow-up data were collected. Medium follow-up was 3.2 years.

RESULTS

The prevalence of thoracic sarcopaenia was 16.7% in this study. The incidence of total complications and in-hospital mortality were higher in thoracic sarcopaenia group (p=0.024 and p=0.014, respectively). Multivariate analysis revealed that thoracic sarcopaenia is a significant predictor for postoperative complications (OR 2.319; 95% CI 1.003-5.366; p=0.049). Decreased long-term survival was observed in patients with thoracic sarcopaenia. Thoracic sarcopaenia (HR 4.178; 95% CI 2.062-8.465; p<0.001) was determined to be an independent risk factor for late mortality.

CONCLUSION

Thoracic sarcopaenia defined by chest CT was independently associated with higher incidence of postoperative complications and long-term mortality. Routine preoperative evaluation of thoracic sarcopaenia deserves further consideration to enhance the predictive performance for operation risk.

Chest computed tomography-derived muscle mass and quality indicators, in-hospital outcomes, and costs in older inpatients

BACKGROUND

Muscle mass and muscle quality assessed by computed tomography (CT) have been associated with poor prognosis in oncology and surgery patients, but the relevant evidence was limited in older patients. We hypothesized that muscle mass and muscle quality indicators derived from opportunistic chest CT images at the 12th thorax vertebra level (T12) could predict in-hospital death, length of hospital stay (hospital LOS), and hospital costs among older patients in acute care wards.

METHODS

We conducted a prospective cohort study. Older patients admitted to the acute geriatric wards of a teaching hospital were continuously recruited. Chest CT images were analysed using SliceOmatic software. The skeletal muscle area, skeletal muscle radiodensity, and intermuscular adipose tissue (IMAT) at the T12 level were measured. Skeletal muscle index (SMI) was calculated using skeletal muscle area divided by body height squared.

RESULTS

We included 1135 older patients with a median age of 80 years (interquartile range, 73 to 85 years), 498 (44%) were women, 148 (13%) patients died during hospitalization. The SMI and SMD were negatively correlated to age (ρ = -0.11, P < 0.001, ρ = -0.30, P < 0.001, respectively), whereas the IMAT was positively correlated to age (ρ = 0.27, P < 0.001). Compared with survivors, dead patients had significantly lower SMI in men (P < 0.001) but not in women (P = 0.760). After adjusting for sex and other potential confounders, the SMI [increased per 1 cm² /m² , odds ratio (OR) 0.96, 95% confidence interval (CI) 0.93 to 0.99] and SMD (increased per 1 Hounsfield unit, OR 0.93, 95% CI 0.90 to 0.96) were negatively and independently associated with in-hospital death, whereas the IMAT (increased per 1 cm² , OR 1.09, 95% CI 1.05 to 1.14) was independently and positively associated with in-hospital death. None of the SMI, SMD, or IMAT was significantly related to long hospital LOS or increased hospital costs.

CONCLUSIONS

Chest CT-derived muscle mass indicator (T12 SMI) and muscle quality indicators (T12 SMD and T12 IMAT) may serve as prognostic factors for predicting in-hospital death among older inpatients. Opportunistic chest CT images might be an overlooked resource for measuring muscle mass and muscle quality and for predicting short-term prognosis in older inpatients.

Predicting mortality in elderly trauma patients: a review of the current literature

PURPOSE OF REVIEW

Advances in medical care allow patients to live longer, translating into a larger geriatric patient population. Adverse outcomes increase with older age, regardless of injury severity. Age, comorbidities, and physiologic deterioration have been associated with the increased mortality seen in geriatric trauma patients. As such, outcome prediction models are critical to guide clinical decision making and goals of care discussions for this population. The purpose of this review was to evaluate the various outcome prediction models for geriatric trauma patients.

RECENT FINDINGS

There are several prediction models used for predicting mortality in elderly trauma patients. The Geriatric Trauma Outcome Score (GTOS) is a validated and accurate predictor of mortality in geriatric trauma patients and performs equally if not better to traditional scores such as the Trauma and Injury Severity Score. However, studies recommend medical comorbidities be included in outcome prediction models for geriatric patients to further improve performance.

SUMMARY

The ideal outcome prediction model for geriatric trauma patients has not been identified. The GTOS demonstrates accurate predictive ability in elderly trauma patients. The addition of medical comorbidities as a variable in outcome prediction tools may result in superior performance; however, additional research is warranted.

Establishment and Validation of Pre-Therapy Cervical Vertebrae Muscle Quantification as a Prognostic Marker of Sarcopenia in Patients With Head and Neck Cancer

Background

Sarcopenia is prognostic for survival in patients with head and neck cancer (HNC). However, identification of this high-risk feature remains challenging without computed tomography (CT) imaging of the abdomen or thorax. Herein, we establish sarcopenia thresholds at the C3 level and determine if C3 sarcopenia is associated with survival in patients with HNC.

Methods

This retrospective cohort study was conducted in consecutive patients with a squamous cell carcinoma of the head and neck with cross-sectional abdominal or neck imaging within 60 days prior to treatment. Measurement of cross-sectional muscle area at L3 and C3 levels was performed from CT imaging. Primary study outcome was overall survival.

Results

Skeletal muscle area at C3 was strongly correlated with the L3 level in both men (n = 188; r = 0.77; p < 0.001) and women (n = 65; r = 0.80; p < 0.001), and C3 sarcopenia thresholds of 14.0 cm²/m² (men) and 11.1 cm²/m² (women) were best predictive of L3 sarcopenia thresholds. Applying these C3 thresholds to a cohort of patients with neck imaging alone revealed that C3 sarcopenia was independently associated with reduced overall survival in men (HR = 2.63; 95% CI, 1.79, 3.85) but not women (HR = 1.18, 95% CI, 0.76, 1.85).

Conclusions

This study identifies sarcopenia thresholds at the C3 level that best predict L3 sarcopenia in men and women. In HNC, C3-defined sarcopenia is associated with poor survival outcomes in men, but not women, suggesting sarcopenia may differentially affect men and women with HNC.

Correlation Between Bioelectrical Impedance Analysis and Chest CT-Measured Erector Spinae Muscle Area: A Cross-Sectional Study

BACKGROUND

Skeletal muscle mass (SMM) plays an important part in diverse health and disease states. Bioelectrical impedance analysis (BIA) and computed tomography (CT) are available for its assessment. However, muscle mass assessed by BIA may be influenced by multiple factors. The erector spinae muscle area (ESA) on chest CT is recently presumed to be representative of SMM. This study aimed to derive BIA from the ESA and evaluate the magnitude of association (between ESA measured from chest CT) and BIA.

METHODS

Subjects hospitalized for health checkups between December 2020 and December 2021, having undergone both BIA (50 kHz, 0.8 mA) and chest CT, were included. ESA was quantified at the level of the 12th thoracic vertebra (T12-ESA) by a standardized semi-automated segmentation algorithm. Low SMM was defined using the Asian Working Group for Sarcopenia criteria. The association between T12-ESA and BIA was then evaluated. Stratified analyses by sex and BMI were also performed.

RESULTS

Among 606 included subjects (59.7 ± 16.6 years, 63.5% male), 110 (18.2%) had low SMM. BMI in low and normal SMM groups was 20.1 and 24.7 kg/m², respectively. Current smoking, drinking, chronic obstructive pulmonary disease, and chronic renal dysfunction were more frequently seen in the low SMM group than in the normal SMM group. The final regression model included T12-ESA, weight, BMI, and age, and had an adjusted R² of 0.806 with BIA. In the validation group, the correlation between T12-ESA-derived BIA and BIA remained high (Pearson correlation = 0.899). Stratified analysis disclosed a stronger correlation between T12-ESA and BIA in male subjects than in female subjects (adjusted R² = 0.790 vs. adjusted R² = 0.711, p < 0.05), and a better correlation was observed in obese (BMI ≥ 30 kg/m²) compared with underweight (BMI < 18.5 kg/m²) subjects (adjusted R^{2 =} 0.852 vs. adjusted R² = 0.723, p < 0.05). Additional analysis revealed a significant correlation between T12-ESA and skeletal muscle cross-sectional area at the 3rd lumbar vertebra (L3-CSA) (adjusted R² = 0.935, p < 0.001).

CONCLUSIONS

CT-based assessment of ESA at the T12 level is feasible and correlated well with BIA, especially in male subjects and obese subjects.

Malnutrition in Relation to Muscle Mass, Muscle Quality, and Muscle Strength in Hospitalized Older Adults

OBJECTIVES

Muscle quality is an essential muscle metric, which can be assessed by measuring intermuscular adipose tissue (IMAT) and skeletal muscle radiodensity (SMD) via computed tomography (CT) images. We aimed to explore the associations of Global Leadership Initiative on Malnutrition (GLIM)-defined malnutrition with muscle mass, muscle quality, and muscle strength in hospitalized older adults.

DESIGN

A cross-sectional study.

SETTING AND PARTICIPANTS

Hospitalized older patients.

METHODS

Malnutrition was defined by the GLIM criteria after screening by the Mini Nutrition Assessment-Short Form (MNA-SF). Chest CT images were used to segment skeletal muscle area (SMA) and IMAT, and to measure SMD. Skeletal muscle index (SMI) was calculated by SMA (cm²)/body height squared (m²). Handgrip strength (HGS) was measured using a digital dynameter. Univariate and multivariate logistic regression models were performed to calculate odds ratios (ORs) and 95% CIs.

RESULTS

We included 1135 patients. The MNA-SF score is positively associated with SMI, SMD, and HGS, but negatively associated with IMAT. Compared to patients with normal nutrition, patients with malnutrition had significantly lower SMD and HGS in both men and women. Women with malnutrition had significantly higher IMAT than women with normal nutrition, whereas men with malnutrition had significantly lower SMI than men with normal nutrition. After adjustment for confounders, SMI (adjusted OR 0.95, 95% CI 0.93, 0.98), SMD (adjusted OR 0.94, 95% CI 0.93, 0.98), and HGS (adjusted OR 0.91, 95% CI 0.89, 0.94) were significantly and negatively associated with malnutrition. IMAT appeared to be positively associated with malnutrition, but the result was not statistically significant (adjusted OR 1.03, 95% CI 1.00, 1.07).

CONCLUSIONS AND IMPLICATIONS

Our study provides new evidence regarding the association between handgrip strength and malnutrition in older inpatients. Moreover, a small association of chest CT--derived muscle quality and mass with malnutrition is identified.

Diagnosing sarcopenia and myosteatosis based on chest computed tomography images in healthy Chinese adults

BACKGROUND

Measuring muscle mass and muscle quality based on chest Computed Tomography (CT) images would facilitate sarcopenia and myosteatosis research. We aimed (1) to measure muscle mass and myosteatosis based on chest CT images at the 12th thoracic vertebra level and compare the relevant indicators with whole-body skeletal muscle mass (BSM) and whole-body fat mass (BFM) measured by bioelectrical impedance analysis; and (2) to determine the cut-off points of these indicators for diagnosing sarcopenia or myosteatosis in healthy Chinese adults.

METHODS

Chest CT images were analyzed using a segmentation software. Skeletal muscle area (SMA), skeletal muscle radiodensity (SMD), and intermuscular adiposity tissue (IMAT) were measured. Skeletal muscle indices (SMIs) and IMAT/SMA ratio were calculated.

RESULTS

We included 569 participants. SMA, SMA/height2, and SMA/BMI were strongly and positively correlated with BSM (r = 0.90, 0.72, and 0.69, respectively, all p < 0.001); whereas SMA/weight was moderately and positively correlated with BSM (r = 0.38, p < 0.001). IMAT and IMAT/SMA were strongly and positively correlated with BFM (r = 0.67 and 0.58, respectively, both p < 0.001). SMD was moderately and negatively correlated with BFM (r = - 0.40, p < 0.001). We suggest SMA/height2 (< 25.75 cm2/m2 in men and < 20.16 cm2/m2 in women) for diagnosing sarcopenia and SMD (< 37.42 HU in men and < 33.17 HU in women) or IMAT (> 8.72 cm2 in men and > 4.58 cm2 in women) for diagnosing myosteatosis.

CONCLUSIONS

Muscle mass indicators (SMA and SMIs) and muscle quality indicators (SMD, IMAT, and IMAT/SMA) measured by chest CT images are valuable for diagnosing sarcopenia and myosteatosis, respectively.

Factors That Improve Chest Computed Tomography-Defined Sarcopenia Prognosis in Advanced Non-Small Cell Lung Cancer

BACKGROUND

Whether muscle strength and physical performance should be components of sarcopenia remains controversial. This study evaluated the skeletal muscle index derived from computed tomography images at the 12th thoracic vertebra level (T12 SMI), handgrip strength, performance status, and their combination for predicting overall survival in patients with advanced non-small cell lung cancer.

METHODS

Chest computed tomography, handgrip strength measurement, and bioelectrical impedance analysis were performed. Sarcopenia was defined based on the T12 SMI alone or the T12 SMI, handgrip, and/or physical performance (i.e. Asian Working Group for Sarcopenia [AWGS]-defined sarcopenia or severe sarcopenia).

RESULTS

Overall, 639 participants were included; 488 (76.4%) died. At baseline, 160 (25.0%), 141 (22.1%), and 42 (6.6%) patients had computed tomography-defined sarcopenia, AWGS-defined sarcopenia, and AWGS-defined severe sarcopenia, respectively. Chest computed tomography-defined sarcopenia (hazard ratio [HR], 2.00; 95% confidence interval [CI], 1.65-2.43), AWGS-defined sarcopenia (HR, 2.00; 95% CI, 1.59-2.49), and AWGS-defined severe sarcopenia (HR, 3.01; 95% CI, 2.21-4.09) were more strongly associated with poor prognosis than a performance status score ≥2 (HR, 1.37; 95% CI, 1.10-1.73).

CONCLUSIONS

Adding handgrip strength and the performance status score to chest computed tomography-defined sarcopenia improved its prognostic ability. Oncological sarcopenia research should focus on muscle mass, strength, and function.

Preoperative paraspinous muscle sarcopenia and physical performance as prognostic indicators in non-small-cell lung cancer

BACKGROUND

Despite the associations of both preoperative sarcopenia and physical performance with post-operative mortality in non-small-cell lung cancer (NSCLC), there have been no comprehensive studies of the impact of physical status on prognosis. This study was performed to investigate the prognostic significance of preoperative sarcopenia and physical performance in NSCLC.

METHODS

This retrospective cohort study was performed in NSCLS patients undergoing curative lung resection at a university hospital between January 2014 and December 2017. The patients were divided into four groups according to the skeletal muscle index [sarcopenia (lowest sex-specific tertile) and non-sarcopenia] and 6 min walking distance (6MWD) [short distance (<400 m) and long distance (≥400 m)]. Sarcopenia was assessed by preoperative cross-sectional areas of right and left paraspinous muscles at the level of the 12th thoracic vertebra from computed tomography images, and physical performance was determined by preoperative 6MWD. The primary and secondary endpoints were post-operative overall survival (OS) and disease-free survival (DFS).

RESULTS

The 587 patients [mean age: 68.5 ± 8.8 years, 399 men (68%)] included in the study were divided into the non-sarcopenia/long-distance group (58%), sarcopenia/long-distance group (26%), non-sarcopenia/short-distance group (9%), and sarcopenia/short-distance group (7%). A total of 109 (18.6%) deaths and 209 (35.6%) combined endpoints were observed over a mean follow-up of 3.1 ± 1.3 years. After adjusting for other covariates, the sarcopenia/short-distance group showed significant associations with shorter OS (hazard ratio, 3.38; 95% confidence interval, 1.79-6.37; P < 0.001) and DFS (hazard ratio, 2.11; 95% confidence, 1.27-3.51; P = 0.004) compared with the non-sarcopenia/long-distance group on multivariate analyses. Although not significant, adding skeletal muscle index and 6MWD to the pre-existing risk model increased the area under the curve on time-dependent receiver operating characteristic curve analysis for OS and DFS, except within 2 years of surgery.

CONCLUSIONS

The presence of both preoperative paraspinous muscle sarcopenia and short distance in 6MWD had an adverse effect on post-operative prognosis in patients with NSCLC, suggesting that preoperative assessment of thoracic sarcopenia and physical performance may be useful for risk stratification of surgical candidates with potential for targeted interventions.